This research project assesses the ability of disparate electronic health records (EHRs) to collect standardized, risk adjusted and clinically relevant outcome measures. The introduction of the EHR holds promise for robust risk adjustment modeling that will enable fair comparisons of outcomes across different patients, treatments, providers, or populations without the costs associated with labor intensive data collection. To date the retooling of quality measures from paper-based formats to an electronic (eMeasure) format has primarily focused on measures of health care processes. As a result, the activities required to develop and disseminate risk models within the eMeasure framework have not been addressed. This is a critical gap, as risk adjustment is essential to our ability to make fair comparisons of outcome across different organizations and patient populations. This project will evaluate the retooling of long established and well respected outcome measures that address cardiac care in New York State. Specifically, this project will: Aim 1: Develop practical recommendations for retooling the paper-based NYS Cardiac Care measures into eMeasure specifications based upon an evaluation of: a). The feasibility of collecting the specific data elements using an EHR; b). The statistical influence of specific risk factors (currently used in th NYS Cardiac Care measure) and a determination of the impact of alternatives to those risk factors that cannot feasibly be collected through the EHR; c). How to best represent the clinical intent of data elements in an EHR (e.g. value sets); d). Estimate costs associated with recommendations to modify existing EHRs which may be needed to capture critical data elements (including a determination of how the inclusion of such data elements might impact clinician work flow). Aim 2: Retool the paper-based NYS Cardiac Care measure specifications into eMeasure specifications so that data from diverse EHR systems can be equivalently mapped to the measure data elements (including risk factors) that are required to collect the data and calculate the measure. The results of this project will provide valuable information about how to establish standardized risk adjusted outcomes measures in the EHR environment. At the public policy level, the results will facilitate the creation of national performance comparisons which can stimulate quality improvement, and inform public and private efforts to enhance consumer choice and provider accountability.